Here we provide a brief introduction to the medical benefits of CBD and medical Cannabis, with an overview of treatments that have been implemented
Medical Cannabis and CBD oil is the wide range of medical applications they offer. These applications fall broadly into three spheres of treatment; pain management, treatment of complex motor disorders, and mental health care.
The UK is gradually introducing forms of Medical Cannabis and CBD oil as a legal treatment option available on the NHS; at present only for pain management and for the treatment of complex motor disorders. CBD oil was introduced for medicinal purposes in 2016, and then in June 2018 the Home Office launched a review into the scheduling of cannabis and cannabis-based products for medicinal purposes, in which “Professor Dame Sally Davies, Chief Medical Officer (CMO) for England and Chief Medical Advisor to the UK Government, assessed the therapeutic and medicinal benefits of cannabis-based products for medicinal use in humans on prescription, and found that there is conclusive evidence of therapeutic benefit for certain medical conditions, and reasonable evidence in several other medical conditions.” Additionally, CBD can be legally bought in high street stores as a “nutrition supplement.”
CBD and pain management
Medical marijuana is probably most commonly associated in the popular imagination with managing pain related to arthritis and cancer – and not without reason. The connection between THC and CBD and cancer has been clinically studied for over 50 years.
In 2017 Blake et al published a review of clinical trials into this subject dating back to 1975. Medical marijuana is also used to manage nausea and vomiting caused by chemotherapy- in the UK the artificial cannabis product Nabilone is licensed for precisely this purpose. Rather than CBD, Nabilione, in fact, mimics tetrahydrocannabinol (THC), the psychoactive component of marijuana.
Medical Marijuana cannot currently be used in the UK for the treatment of Arthritis, as clinical trials to date have focussed primarily on animal models. Primary studies have focussed on rats, such as this study from 2000 and this follow up study from 2014, which found similar results. With increased clinical trials, no doubt this area of treatment will rapidly expand.
Interestingly, CBD has also shown great promise in the treatment of topical pain. CBD’s ability to provide effective pain relief without the inhibition of wound healing make it a promising replacement for opioids- which have a high rate of both addiction and accidental overdose.
Medical cannabis, CBD and complex motor disorders
Much of the drive behind legalizing marijuana products for medical use has come from the proven efficacy in treating complex motor disorders including epilepsy, spasticity and dystonia, and dravet syndrome.
In the UK, Sativex, which is a 50-50 mix of THC and CBD produced in a lab, has been approved for use in the UK by the MHRA as a treatment for multiple sclerosis. However, in 2014, the National Institute for Health and Care Excellence, which issues guidance to NHS doctors, gave the medicine “do not recommend” status, saying it was not cost-effective
Clinical research in this area has greatly increased in the past few years. In just the past year alone Hausman-Kedern et al published a longitudinal study into the use of CBD for the treatment of refractory epilepsy, Porcari et al studied artisanal CBD as an adjunct therapy to epilepsy, and Libzon et al published study on the efficacy, safety, and tolerability of medical cannabis in children with complex motor disorder
CBD and mental health
This is the least developed realm of treatment, however research to date shows that CBD and medical marijuana shows promise in treating; dementia, cannabis dependence, tobacco and opioid dependence, psychoses and schizophrenia, general social anxiety, posttraumatic stress disorder, anorexia nervosa, attention-deficit hyperactivity disorder, Parkinson’s disease and Tourette’s disorder.
CBD can in fact “counteract the undesirable effects of the psychoactive cannabinoid Δ9-tetrahydrocannabinol (Δ9-THC) that hinder clinical development of cannabis-based therapies” as “CBD blunts Δ9-THC-induced cognitive impairment in an adenosine A2A receptor (A2AR)-dependent manner.”
Consumer interest has been particularly focussed on the use of CBD for anxiety. Multiple studies have found that CBD use significantly reduces anxiety. Shannon et al found 79.2% reduction in anxiety after the first month, and Kamal et al found similar effectiveness.
- Bazian Ltd.Edited by NHS Website “Could cannabis compound soothe arthritis pain?” NHS News: Medication [Online] 07.01.2014
- Blake, Alexia, Bo Angela Wan, Leila Malek, Carlo DeAngelis, Patrick Diaz, Nicholas Lao, Edward Chow, & Shannon O’Hearn. “A selective review of medical cannabis in cancer pain management.” Annals of Palliative Medicine [Online], 6.2 (2017): S215-S222. Web. 6 Feb. 2019
- Burston JJ, Sagar DR, Shao P, Bai M, King E, et al. “Cannabinoid CB2 Receptors Regulate Central Sensitization and Pain Responses Associated with Osteoarthritis of the Knee Joint” (2013) 8(11): e80440.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080440
- Department of Health and Social Care “Cannabis-based products for medicinal use.” Gateway Publications clearance: 08539 [Online] 31.10.2018
- Hausman-Kedem, Moran et al. “Efficacy of CBD-enriched medical cannabis for treatment of refractory epilepsy in children and adolescents – An observational, longitudinal study.” Brain and Development, Volume 40 , Issue 7 , 544 – 551, https://linkinghub.elsevier.com/retrieve/pii/S0387760418301128
- Kamal, Brishna S et al. “Cannabis and the Anxiety of Fragmentation-A Systems Approach for Finding an Anxiolytic Cannabis Chemotype” Frontiers in neuroscience vol. 12 730. 22 Oct. 2018, /https://www.frontiersin.org/articles/10.3389/fnins.2018.00730/full
- Libzon, S., Schleider, L. B.-L., Saban, N., Levit, L., Tamari, Y., Linder, I., … Blumkin, L. (2018). “Medical Cannabis for Pediatric Moderate to Severe Complex Motor Disorders.” Journal of Child Neurology, 33(9), 565–571.https://journals.sagepub.com/doi/10.1177/0883073818773028
- Maida, Vincent et al. “Topical Medical Cannabis: A New Treatment for Wound Pain—Three Cases of Pyoderma Gangrenosum.” Journal of Pain and Symptom Management , Volume 54 , Issue 5 , 732 – 736
- Malfait AM, Gallily R, Sumariwalla PF, et al. “The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis.” Proc Natl Acad Sci USA. 2000;97(17):9561-6. https://www.pnas.org/doi/full/10.1073/pnas.160105897
- Michaels, Alex. “The Medical Benefits of CBD: Reviewing the Literature.” CBD Health Store: CBD News UK. [Online] 21.02.2019
- NICE, National Institute for Health and Care Excellence. “Multiple sclerosis in adults: management” Clinical guideline [CG186] [Online] October 2014
- Porcari, Giulia S. et al. “Efficacy of artisanal preparations of cannabidiol for the treatment of epilepsy: Practical experiences in a tertiary medical center.” Epilepsy & Behavior , Volume 80 , 240 – 246 https://linkinghub.elsevier.com/retrieve/pii/S152550501830009X
- Shannon, Scott et al. “Cannabidiol in Anxiety and Sleep: A Large Case Series” Permanente journal vol. 23 (2019): 18-041. https://www.thepermanentejournal.org/doi/10.7812/TPP/18-041